1407432479 NPI number — PROREHAB, INC

Table of content: (NPI 1407432479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407432479 NPI number — PROREHAB, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROREHAB, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED THERAPY INNOVATIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407432479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47716-5629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-401-3258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5236 VOGEL RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47715-7814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-437-7868
Provider Business Practice Location Address Fax Number:
812-737-7228
Provider Enumeration Date:
03/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMANN
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
812-759-7473

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com